Men’s group faults new HMO criteria
The recently released Health Plan Employer Data and Information Set (HEDIS) guidelines include 12 specifically female-oriented health care measures. Ed Bartlett, PhD, senior policy advisor for Men’s Health America in Rockville, MD, contends that they represent a serious oversight. "From a quality perspective, health plans are supposed to promote health for populations," he says. "The new measures do not address the factors that contribute to men dying seven years earlier, on average, than women."
Bartlett points out that for each of the top 10 causes of death in this country, men have disproportionately higher mortality rates than women. Heading the list are heart disease and cancer — and not just prostate cancer. The fact that men are less likely than women to seek medical care means they should be the target of more aggressive education initiatives by HMOs, he adds.
The National Committee on Quality Assurance (NCQA) takes the position that many of its measures automatically address gender disparity in disease and mortality rates. Brian Schilling, spokesman for the Washington, DC-based agency says the NCQA’s goal is to "put in measures that do the most good for the most people. We would be the first to admit that HEDIS needs more measures in more health areas," Schilling says. "But we don’t want to put something in place that isn’t going to give us good data about health outcomes, and some of the screening guidelines in men’s health areas are not tested or refined yet." Implementation of new guidelines are expensive for health plans, he adds. That’s why NCQA’s policy is to move slowly on the certainty that changes are founded on hard evidence.
[For more information, contact Ed Bartlett, PhD, Senior Policy Advisor, Men’s Health America, P.O. Box 1404, Rockville, MD 20849. Telephone: (301) 670-1964. E-mail: [email protected]. Contact NCQA at 2000 L St. N.W., Suite 500, Washington, DC 20036. Telephone: (202) 955-3500. Web site: www.ncqa.org.]
Restraint use was already low when nursing leaders at the University of Medicine and Dentistry of New Jersey University Hospital (UMDNJ) in Newark launched a safer alternatives initiative in March 1998. The 500-bed facility’s average was 3.48% compared to a national average of 5.8%.1 Within eight months, UMDNJ’s average restraint use dropped to 2.2%. Project leaders include Chris McCallion, director for patient care services for medicine, psychiatry and emergency; Kathy Ennis, clinical nurse specialist for emergency/trauma service; and Faith Solkoff, director for quality improvement.
4 IMPROVEMENT OPPORTUNITY
While the psychiatric units’ restraint use averaged less than 2%, "we wanted to focus on the differences between the ICU and non-ICU areas," McCallion says. UMDNJ has four ICUs: medical, surgical, cardiac, and neurological. At project launch, ICU restraint use averaged 11.8% (benchmark, 24.3%); non-ICU areas averaged 1.2% (benchmark, 3.4%).
4 Solutions
Action plan:
1. Staff education, including a presentation by an employee who was restrained following a trauma injury, as well as actual experience of being restrained.
2. Improved sedation and ventilator weaning protocols.
3. Restraint alternatives such as one-to-one and group observation of patients, splints to prevent bending the elbow, soft hand mitts to reduce dexterity, and chair padding to prevent patients from sliding out.
4. Revised policies and procedures defining safe restraint use as a last resort.
4 RESULTS
Adult ICU rates dropped from 11.8% to 7.6% (benchmark 24.3%); adult non-ICU 1.2% to 0.6% (benchmark 3.4%); pediatric ICU 3.6% to 1.4% (benchmark 5.2%); pediatric non-ICU 0.3% to .07% (benchmark 5.2%).
4 Keys to success
• Support senior leadership.
• Teach staff that "nothing in the literature proves that restraints are safe," notes McCallion.
• Authorize nurses to question physicians and discuss alternatives to restraint orders.
• Enlist family support. McCallion notes that education and staff support can change family beliefs that their loved ones require restraints for safety.
4 Contact
Faith Solkoff, Director, Quality Improvement, UMDNJ-University Hospital, 150 Bergen Street, UH-C437 Newark, NJ, 07103. Telephone: (973) 972-1530. E-mail: [email protected].
Reference
1. Minnick AF, Mion LC, Leipzig R, et al. Prevalence and patterns of physical restraint use in the acute care setting. J Nurs Adm 1998; 28:19-24.
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